What is the relationship between mast cell activation and elevated vitamin B12 levels?

From the Guidelines

Mast cell activation syndrome (MCAS) may be associated with elevated vitamin B12 levels, though this connection isn't fully understood, and management should focus on treating MCAS symptoms and monitoring B12 levels, as recommended by the most recent guidelines 1.

Key Considerations

• If you have MCAS and high B12, continue any prescribed MCAS treatments such as H1 antihistamines (like cetirizine 10mg daily or fexofenadine 180mg daily), H2 blockers (such as famotidine 20mg twice daily), mast cell stabilizers (like cromolyn sodium 200mg four times daily), or leukotriene inhibitors (such as montelukast 10mg daily) 1.
• Don't stop B12 supplementation without medical advice, as elevated levels might be due to impaired cellular uptake rather than excess.
• A low-histamine diet may help manage MCAS symptoms - avoid fermented foods, aged cheeses, cured meats, alcohol, and certain fruits and vegetables like tomatoes and spinach.

Diagnostic Approach

• The relationship between MCAS and B12 likely involves inflammation affecting B12 transport proteins or liver function, and diagnosis should involve a comprehensive evaluation of MCAS symptoms and B12 levels 1.
• Consult with a healthcare provider specializing in MCAS for personalized treatment, as they may recommend additional testing to determine the cause of your elevated B12 levels.

Treatment Priorities

• Prioritize treating MCAS symptoms and monitoring B12 levels, rather than focusing solely on reducing B12 levels, to minimize the risk of adverse effects and optimize quality of life 1.
• Consider the potential benefits and risks of each treatment option, and discuss these with your healthcare provider to determine the best course of treatment for your individual needs.

From the Research

Mast Cell Activation and Vitamin B12 Levels

There is no direct evidence in the provided studies to suggest a relationship between mast cell activation and elevated vitamin B12 levels.

• The studies focus on the diagnosis, management, and mechanisms of mast cell activation syndrome (MCAS) 2, 3, 4, 5, 6.
• They discuss various triggers, symptoms, and treatments for MCAS, but do not mention vitamin B12 levels.
• The studies highlight the complexity of MCAS and the need for further research to understand its underlying mechanisms and relationships with other conditions 5.
• However, they do not provide any information on the potential link between mast cell activation and vitamin B12 levels.

Related Conditions and Triggers

The studies do discuss various conditions and triggers that may be related to MCAS, such as:

• Allergic and hypersensitivity states 2
• Genetic conditions, such as hereditary alpha tryptasemia 2
• Environmental triggers, such as foods, fragrances, and temperature changes 3
• Medication excipient reactivity 4
• However, none of these studies mention vitamin B12 levels as a potential factor in MCAS.